ACARDIAC TWIN FETUS WITH SEVERE HYDROPS FETALIS AND BILATERAL TALIPES VARUS DEFORMITY

Twin reversed-arterial-perfusion syndrome (TRAPS) is a rare complication of monochorionic twin pregnancies. TRAPS is characterized by the hemodynamic dependence of a “recipient” twin from a “pump” twin. The “recipient” twin exhibits lethal abnormalities, such as acardia and acephaly. Circulatory failure of the normal twin derives from the existence of arterio-arterial and veno-venous anastomoses within the placenta that allow retrograde perfusion of the acardiac twin by blood coming from the normal twin. Acardiac twinning is the most extreme manifestation of the twin-twin transfusion syndrome. This occurs in 1 in 100 monozygotic twin pregnancies and 1 in 35,000 births. We report a case of diamnionic monochorionic female twins in which the acardiac twin demonstrated severe hydrops fetalis and bilateral talipes varus deformity. Cesarean section was performed on a 27-year-old hypertensive gravida 2, para 1 mother for fetal indications at 32 6/7 weeks gestation. The acardiac fetus had a two-vessel umbilical cord measuring 43.5 cm in length and 0.8 cm in diameter. The proximal end inserted into the root of the normal twin's umbilical cord in an acute angle forming a “v” close to the placental disc. Structures rostral to the thorax were absent except for a round mass of flesh with three small buds in place of the head and neck, and bilateral upper extremities. Only the kidneys, right adrenal, small and large intestine, and rudimentary urinary bladder were present. Both feet demonstrated talipes varus deformity. The fetus was severely hydropic. The subcutaneous fat measured 4.5 cm in maximum thickness. The normal twin had a protracted course complicated with respiratory distress syndrome, moderate secundum atrial septal defect with left to right shunt, and thrombocytopenia of prematurity. The baby was eventually discharged after approximately 1 month. At the time of this report, 5 months postpartum, the neonate is growing and developing normally. To our knowledge, this is the first report of severe hydrops fetalis and talipes varus deformity in an acardiac twin.     

鼻内镜下激光凝固中鼻甲前端治疗变应性鼻炎

（1）目的 探讨鼻内窥镜下Nd:YAG激光治疗变应性鼻炎的方法。（2）方法 应用鼻内镜下Nd:YAG激光凝固中务甲前1／3端治疗变应性鼻炎126例。（3） 结果 随访1年，显效109例（86．5％），有效13例（10．3％），无效4例（3．2％），总有效率96．8％。（4）结论 鼻内镜下Nd:YAG激光凝固中鼻甲前1．3端治疗变应性鼻炎，具有视野清楚，操作简便，疗效好等优点，值得临床应用。     

Systematic and random errors in compression testing of trabecular bone

We sought to quantify the systematic and random errors associated with-artifacts in the platens compression test for trabecular bone. Our hypothesis was that while errors may depend on anatomic site, they do not depend on apparent density and therefore have substantial random components. Trabecular bone specimens were first tested nondestructively using newly developed accurate protocols and then were tested again using the platens compression test. Percentage differences in modulus between the techniques (bovine) proximal tibia [n = 18] and humerus [n = 17] and human lumbar spine, [n = 9] were in the range of 4-86%. These differences did not depend on anatomic site (p = 0.21) and were only weakly dependent on apparent density and specimen aspect ratio (r² < 0.10). The mean percentage difference in modulus was 32.6% representing the systematic component of the end-artifact error. Neglecting the minor variations explained by density and specimen size (approximately 10%), an upper bound on the random error from end-artifacts in this experiment was taken as the SD of the modulus difference (±18.2%). Based on a synthesis of data taken from this study and from the literature, we concluded that the systematic underestimation error in the platens compression test can be only approximated and is in the range of 20-40%; the substantial random error (±12.5%) confounds correction, particularly when the sample size is small. These errors should be considered when interpreting results from the platens test, and more accurate testing techniques should be used when such errors are not acceptable.     

单道感应式人工耳蜗装置的研制

感应式人工耳蜗装置将声音信息转变并处理为适当的电信号之后,采用电磁感应的方式将此信号送至植入全聋患者内耳耳蜗靠近听神经纤维的作用电极上,刺激神经发放冲动,使全聋患者恢复音感。本装置经临床全聋患者使用,取得较满意效果。     

浅析《内经》之闭经证治

收集了《内经》有关闭经方面的相关阐述从而探讨闭经的病因病机、诊断与治疗,并详细记述了《内经》对血滞经闭和血枯经闭这两类型经闭的不同治疗法度。     

An occipito-temporal syndrome in adolescents with optimally controlled hyperphenylalaninaemia

Summary The study included 16 adolescents with optimally controlled hyperphenylalaninaemia (McKusick 26160), of whom six did not require treatment according to conventional criteria. All except the two patients with lowest median serum phenylalanine level throughout childhood (most values at 200–300 µmol/L) had white matter abnormalities detectable with magnetic resonance imaging. The lesions were particularly prominent in the watershed regions between the posterior and middle cerebral arteries. In most patients with moderate or severe hyperphenylalaninaemia frontal white matter lesions were present as well. Normal proton magnetic resonance spectra indicated that the lesions were stable. Occipital EEG abnormalities were frequent, and deficient performance on a pattern-recognition test was a characteristic neuropsychological finding. Serum phenylalanine levels at about 300 µmol/L or below throughout childhood and early adolescence may be required to avoid lesions. The present study demonstrates the limitations of even an optimally controlled dietary regimen in hyperphenylalaninaemia.     

原发性阴道癌的放射治疗

原发性阴道癌的治疗方法有单纯放射治疗、手术或手术加放疗、放疗加化疗综合治疗等。治疗方法的选择主要取决于病变部位，病灶大小、期别、各单位医疗条件、医生的经验。原位癌可局部切除或单纯腔内放疗，Ⅰ期和少数Ⅱ期早期可行手术治疗或单纯放疗，Ⅱ期至Ⅳ期行单纯放射治疗或同时性进行放射治疗和化疗。     

豨莶脂溶性成分的研究

从豨莶(Siegesbeckia orientalis L.)的地上部分,分离出八个化合物,其中I和I根据理化性质和光谱数据确定其结构为ent-17-acetoxy-18-isobutyryloxy-16(α)-kauran-19-oicacid(I)和ent-17-ethoxy-16(α)-kauran-19-oicacid(II),均为新化合物,分别被命为豨莶酯酸(siegesesteric acid,I)和豨莶醚酸(siegesetheric acid,I)。其余化合物分别鉴定为腺梗豨莶萜醇酸(ent-16β,17-dihydroxy-kauran-19-oicacid,II),奇任醇(kirenol,IV,β-谷甾醇葡萄糖甙(β-sitosterolglucoside,V),二十一醇(heneicosanol,VI),花生酸甲酯(methyl arachidate,VII)和β-谷甾醇(β-sitosterol,VII)。除奇任醇和β-谷甾醇外,均为首次从该植物中分得。     

地西泮、苯巴比妥、普萘洛尔、和西咪替丁对大鼠肝微粒体安定氧化代谢的影响

研究地西泮、苯巴比妥、普萘洛尔和西咪替丁对地西泮氧化代谢的影响及其药酶蛋白的初步分析，应用HPLC，SDS－聚丙烯酰胺凝胶电泳和薄层扫描测定地西泮及其代谢物，并对大鼠肝微粒体和酶蛋白进行分离和含量测定，结果表明地西泮，普萘洛尔和西咪替丁使肝微粒体中P－450含量明显降低，地西泮和普萘洛尔明显抑制地西泮C3－羟化活性，大剂量普萘洛尔尚能抑制地西泮N－脱甲基，苯巴比妥明显诱导P－450生成，增强地西泮N－脱甲基和C3－羟化酶活性及分子量为51，000和59，000的电泳蛋白带，而地西泮，普萘洛尔则呈抑制作用，并发现，地西泮N－脱甲基酶活性和分子量为59，000蛋白含量呈线性相关（P＜0．05），而C3－羟化酶活性则与51，000蛋白含量呈线性相关（P＜0．01），因此地西泮C3－羟化代谢可能与51，000的P－450酶蛋白有关，而N－脱甲基代谢则可能与59，000的P－450酶蛋白有关。